Reflection – what a waste

Reflection: was there ever a word that made doctors so irate? Barring words like J-Hunt and contract, I suspect ‘reflection’ is probably a top contender for things that make medics sigh. As a term and as a concept, it is ubiquitous in modern day medicine, shoehorning its way into everything. It’s not medical practice anymore, it’s reflective practice. It’s not learning, it’s reflective learning. It’s not breathing, it’s reflective breathing.

Yes, I’m exaggerating – I’m trying to make a point. I’ve just finished medical school, where I’ve spent three years having reflection drilled into me (it didn’t work) and doctors whom I came across in that merry time had been repeatedly forced to write out tortured passages in their ePortfolios. It’s one more box to tick, in training pathways full of tick boxes.

A couple of months ago, I realised what was really going on. I was involved in a series of emails with the administrators from medical school. They had published a set of poorly written and very contradictory guidelines as to what to write, and I was emailing to clarify, and in their response, they shoehorned ‘reflection’ into every nook and cranny. Every section of the essay had to be reflective, the intro, the title, the header and footer. This was absurd, and I realised it then – they didn’t know what reflection was.

No one does.

This is a big problem. Medical educators need to know what reflection is if they are to guide us in becoming reflective practitioners, but they don’t and therefore neither do we, the doctors. Reflection has become a buzzword, an entity that members of the medical world love to use but ultimately has no meaning.

But true reflection does have meaning; it’s useful and rewarding. Reflection is essentially thinking, and then asking yourself questions to develop a deeper insight. It is not formalised, there are no cycles to follow and it certainly does not need to be written down and graded. Your questioning follows your own curiosity, and that makes it rewarding. You’re asking questions to which you want the answer – you’re doing it for yourself.

It’s just thinking, about past, present or future. The best questions are those that ask why or how. Why did I not get on with my patient? How can I be a better doctor? You think, at a distance from those events, allow yourself to be objective and gain insight into your own flaws and strengths as well as those of others. Reflection is not limited to medicine, and Socrates himself was an advocate of reflecting on life. These are different questions, still guided by your own curiosity, and following the what, the how and the why. Why did I fight with the woman I love? How can I be a better father? There are no limits.

Asking these questions allows you to act differently and improve the quality of the medicine you practise and even parts of your personal life. It is certainly something we should all do. So think about it, reflection that is. Try it and see what happens. On your own terms, in your own time, and let your curiosity guide you to questions you want to answer. Oh, and the next time a meducator tells to reflect on something, do me one favour – call bullshit. Show them what it really is.